J Korean Soc Surg Hand.  2013 Sep;18(3):124-131. 10.12790/jkssh.2013.18.3.124.

Percutaneous Multiple Kirschner Wire Fixation in the Treatment of Hand Fractures

• Hong SJ
• Seo HG
• Whang JI
• Cho S

• KMID: 2194142
• DOI: http://doi.org/10.12790/jkssh.2013.18.3.124

Abstract

PURPOSE
We reported results of percutaneous multiple K-wire fixation technique without passing through the joint in patients with a hand fracture.
METHODS
We evaluated a total of 116 cases in 94 patients who underwent percutaneous multiple K-wire fixation on dorsal cortex over a 10-year period between 2001 and 2010. The treatment outcomes were evaluated based on total active motion (TAM), as proposed by Widegrow.
RESULTS
Our clinical series of patients achieved good functional outcomes. Of total patients, 89% (84/94) had excellent TAM, 2% (2/94) did good TAM and 9% (8/94) did poor TAM. Postoperatively, our clinical series of patients had such a good compliance as to achieve a TAM of >181degrees when performing the early active movement. There were no notable postoperative complications during the follow-up period.
CONCLUSION
Our results indicate that percutaneous multiple K-wire fixation technique without passing through the joint from normal bone density patients is effective in providing the rigid fixation. Thus, our patients could perform the early movement as promptly as possible and maintaining the full mobility of the rest of the hand.

Keyword

Hand; Fractures; bone; Fracture fixation; Bone wires; Motion

MeSH Terms

Bone Density
Bone Wires
Compliance
Follow-Up Studies
Fracture Fixation
Hand
Humans
Joints
Postoperative Complications

Figure

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  Fig. 1. Spiral metacarpal fracture with rotational malalignment. (A) Spiral fractures with rotational deformity of the index metacarpal shaft and long metacarpal base. (B) Closed reduction and internal fixation of each spiral fracture with percutaneous multiple K-wires stabilized the fracture yet allow movement. The third and fourth metacarpal function as a foundation stone. No wire was transfixed through the metacarpophalangeal joint surface. (C) On postoperative year 1, no rotational malalignment was observed and patient restored alignment with a full range of motion.

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  Fig. 2. Rigid fixation of comminuted diaphyseal fracture. (A) Diaphyseal fracture of the index proximal phalanx with comminution. (B) Immediately after surgery, with the fixation by percutaneous multiple K-wires without passing through the joint, the rigid fixation was maintained during the active flexion.

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  Fig. 3. Early mobilization after percutaneous multiple K-wire fixation. (A) Proximal phalangeal shaft, base fracture with comminution of the index finger. (B) Closed reduction and percutaneous multiple K-wires. (C) With the rigid fixation without passing through the joint, the early active movement was promoted. The degree of motion was satisfactory on post-operative day 3.

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  Fig. 4. Multiple transverse fractures with concurrent injures. (A) Multiple transverse fractures of the shaft with the tendon injures in the proximal phalanges accompanied by the dorsal, concave angulation. (B) Immediately after surgery, the rigid fixation and the early active motion were achieved using the percutaneous multiple K-wire technique. (C) On postoperative year 1, the full range of motion was restored and there were no residual disabilities or deformities.

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